We propose to implement a health information technology (HIT) system with added best-practices decision support modules in seven nursing homes and evaluate the impact on care processes, resident health outcomes, and staff efficiency and satisfaction. The study will: 1. Lead a collaborative partnership to analyze and redesign clinical workflow, integrate research-based best practices into daily work using HIT to improve clinical practices, and sustain measurable improvements in health outcomes. 2. Implement and use HIT to improve clinical practice via user-friendly technology coupled with intensive workflow analysis and redesign, comprehensive documentation, compilation of summary information by resident or resident population, adherence to clinical guidelines, accurate and timely medication administration, and ongoing review and changes to resident plan of care to meet resident needs based on best practices. 3. Impact resident health outcomes by integrating research-based best practices into daily work using HIT. Comprehensive evaluation will address: a. What is the impact of HIT on resident clinical outcomes: fewer pressure ulcers, fewer hospitalizations, and less use of restraints? b. What is the impact of HIT on preventable adverse events: less weight loss, less decline in ADLs, fewer adverse drug events? 4. Distill and summarize lessons learned about what is critical for successful implementation of HIT in nursing homes, including facilitators, barriers, and strategies to address them.